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Date:
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Name of Dog You Wish to Adopt 1:
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Name of Dog You Wish to Adopt 2:
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Name of Dog You Wish to Adopt 3:
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Applicant's Name:
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| Address:
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| City-State-Zip:
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| Home #:
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| Work #:
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| Cell #:
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| e-mail address:
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| Retype email:
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| Number of persons in your household:
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Children? Yes
No
If Yes, what are their ages?
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| Do you Own or Rent your home?
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Does your homeowner's association or landlord restrict pet ownership?
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If renting, please provide the name and telephone number of your present landlord:
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Landlord's Name:
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Landlord's phone:
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Is your yard fenced?
Yes
No
If Yes, describe what type and what height fencing is:
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| CARE AND RESPONSIBILITY
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| Who will be the primary care giver of the dog?
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Where will the dog be kept?
Indoors Only
Outdoors Only
both in/out
Explain:
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| How much time will the dog spend outside?
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| Will anyone be home during the day?
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| How many hours will the dog be left unattended?
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| When you are home, where will the dog be kept?
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| When you are not at home, where will the dog be kept?
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| Where will the dog sleep?
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Do children frequently visit your home?
Yes
No
If yes children, what are their ages?
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Does anyone in your house have allergies?
Yes
No
If yes to allergies, explain:
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| How would you describe the activity level in your household?
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| Do you understand and accept that changing a dog's environment may cause the dog to have accidents, especially in the early days of adoption?
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| Are you willing to take the time to work with the dog on housebreaking issues, should the need arise?
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| If a behavioral problem arises, what steps will you take to work on it?
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| Are you prepared to make a commitment to care for this dog for the next 10-15 years?
Yes
No
don't know
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Are you prepared to commit to find a home where you can keep this dog, when and if you move during the next 10-20 years?
Yes
No
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| Are you financially prepared to deal with the cost of both routine (vaccinations, annual examinations, dental cleanings, heartworm treatment, etc.) and non-routine/emergency veterinarian care of this dog?
Yes
No
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| If your dog becomes sick or injured, are you financially able to spend $500.00 or more for veterinary care?
Yes
No
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Please estimate the annual cost of the following:
***Premium Food many cockers have food allergies
***Vet Care including shots, heartworm preventative, ear, eye, and teeth maintenance
****Extras such as grooming, beds, bowls, toys, leash, ID tag, etc.
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| HISTORY OF PET OWNERSHIP:
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| Other pets presently in your household (describe type, size, ages, neutered/spayed and where housed) :
Or None
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Have you had pets in the past (other than listed above)?
Yes
No
If yes other pets in the past, where are they now?
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Have you ever given any of your animals away for any reason?
Yes
No
If Yes that you have given away any of your animals, please explain:
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What do you consider a good and valid reason for giving up a dog?
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What is the name of the veterinary hospital where your animal(s) has/have received care and vaccinations?
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| Vet's Phone with area code:
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Do you have a different vet in mind for your new pet?
Yes
No
If yes, please specify, and explain why you are changing vets:
Check here if 'NO VET'.
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If this is a long-distance adoption are you willing to:
Travel to get the dog (by plane, car or both?)
Yes
No
Pay for the cost of transportation?
Yes
No
Meet somewhere along the way?
Yes
No
Unable/Unwilling to travel or assume costs.
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| If, for any reason, you are unable to keep your dog, do you agree to notify Cherished Cockers immediately?
Yes
No
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| If you are unable to keep your dog, do you agree to return him/her to Cherished Cockers without hesitation?
Yes
No
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If your adoption involves traveling more than 25 miles for our volunteers,
and you find yourself unable to keep your dog, are you willing to bear the responsibility, including travel
and financial responsibility, for returning the dog to Cherished Cockers?
Yes
No
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| Are you aware and do you Accept that Cherished
Cockers charges a non refundable donation for our dogsYes
No
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| Please list any preferences you have in adopting a dog (age, sex, breed, personality, etc.)
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| Have you ever adopted a pet from a rescue or animal shelter?
Yes
No
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| Do you still have this pet?
Yes
No
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Please list 2 personal references:
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| Name:
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Phone:
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| Name:
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Phone:
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| Please list any concerns or final questions here:
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I have read the above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions and sign the application can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand and accept that Cherished Cockers has the right to annul the adoption and reclaim the dog.
I give Cherished Cockers permission to fully investigate the information provided as well as contact veterinarians and related officials. If the application passes this review, I agree to a home and yard visit on mutually agreed date by a Cherished Cocker representative before an adoption decision is made.
Furthermore, I understand and accept that the adoption decision depends upon many factors,
including - but not limited to - the compatibility of the family and home to the individual
dog and other applications received on the dog. I understand and accept that it is the
Cherished Cockers prerogative to decide which home is most appropriate for the individual
dog, and therefore, I will not take issue with the decision. Unless otherwise indicated
by Cherished Cockers, I may be considered for another dog.
(For purposes of this application, printing your name is equivalent to a signature.)
SIGNATURE:
DATE:
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